Pediatrix Medical Group, Inc. (NYSE: MD) today provided
commentary on the final rule issued on August 19, 2022 by the
Departments of the Treasury, Labor, and Health and Human Services
related to the No Surprises Act.
The final rule states that a qualifying payment amount (QPA),
described as a calculation of a median in-network rate, is only one
of multiple inputs to be considered by the arbitrators in the
independent dispute resolution (IDR) process by which
out-of-network providers and insurers are required to arbitrate
payment rates, and that the very important non-QPA factors must
also be considered by the arbitrators. These factors are:
1) The level of training, experience, and
quality and outcomes measurements of the provider or facility that
furnished the qualified IDR item or service (such as those endorsed
by the consensus-based entity authorized in section 1890 of the
Social Security Act). 2) The market share held by the provider or
facility or that of the plan or issuer in the geographic region in
which the qualified IDR item or service was provided. 3) The acuity
of the participant, beneficiary, or enrollee who received the
qualified IDR item or service, or the complexity of furnishing the
qualified IDR item or service to the participant, beneficiary, or
enrollee. 4) The teaching status, case mix, and scope of services
of the facility that furnished the qualified IDR item or service,
if applicable. 5) Demonstration of good faith efforts (or lack
thereof) made by the provider or facility or the plan or issuer to
enter into network agreements with each other, and, if applicable,
contracted rates between the provider or facility and the plan or
issuer during the previous four plan years.
These factors, which were part of the bipartisan legislation,
are important to Pediatrix, as the nation’s leading provider of
very high-acuity and broad-based care to mothers, babies and
children.
The Company also believes that the Departments should have
explicitly prescribed the proper calculation of the QPA since the
Departments are aware of improprieties by payors that can be used
to manipulate the QPA, as evidenced by the many examples cited in
the rule. Fortunately, in several parts of the rule, including the
more detailed “Frequently Asked Questions,” the Departments shine a
bright light on potential payor manipulation and provide language
to safeguard against misuse.
Pediatrix intends to do everything necessary to make certain
that payors do not violate the rules that were just released. Such
violations could put at risk the very necessary continuity of care
for mothers, babies and children at their most vulnerable hours,
days and weeks.
Finally, Pediatrix is pleased that the Departments intend future
rules, which the Company expects will provide more clarity and
better protection for the doctor-patient relationship.
ABOUT PEDIATRIX MEDICAL GROUP
Pediatrix® Medical Group, Inc. (NYSE: MD) is the nation’s
leading provider of physician services. Pediatrix-affiliated
clinicians are committed to providing coordinated, compassionate
and clinically excellent services to women, babies and children
across the continuum of care, both in hospital settings and
office-based practices. Specialties include obstetrics,
maternal-fetal medicine and neonatology complemented by more than
20 pediatric subspecialties, as well as a newly expanded area of
pediatric primary and urgent care clinics. The group’s
high-quality, evidence-based care is bolstered by significant
investments in research, education, quality-improvement and safety
initiatives. The physician-led company was founded in 1979 as a
single neonatology practice and today provides its highly
specialized and often critical care services through more than
4,800 affiliated physicians and other clinicians in 37 states and
Puerto Rico. To learn more about Pediatrix, visit www.pediatrix.com
or follow us on Facebook, Instagram, LinkedIn, Twitter and the
Pediatrix blog. Investment information can be found at
www.pediatrix.com/investors.
Certain statements and information in this press release may be
deemed to contain forward-looking statements within the meaning of
the Private Securities Litigation Reform Act of 1995, Section 27A
of the Securities Act of 1933, as amended (the “Securities Act”),
and Section 21E of the Securities Exchange Act of 1934, as amended.
Forward-looking statements may include, but are not limited to,
statements relating to the Company’s objectives, plans and
strategies, and all statements, other than statements of historical
facts, that address activities, events or developments that we
intend, expect, project, believe or anticipate will or may occur in
the future. These statements are often characterized by terminology
such as “believe,” “hope,” “may,” “anticipate,” “should,” “intend,”
“plan,” “will,” “expect,” “estimate,” “project,” “positioned,”
“strategy” and similar expressions, and are based on assumptions
and assessments made by the Company’s management in light of their
experience and their perception of historical trends, current
conditions, expected future developments and other factors they
believe to be appropriate. Any forward-looking statements in this
press release are made as of the date hereof, and the Company
undertakes no duty to update or revise any such statements, whether
as a result of new information, future events or otherwise.
Forward-looking statements are not guarantees of future performance
and are subject to risks and uncertainties. Important factors that
could cause actual results, developments, and business decisions to
differ materially from forward-looking statements are described in
the Company’s most recent Annual Report on Form 10-K and its
Quarterly Reports on Form 10-Q, including the sections entitled
“Risk Factors”, as well the Company’s current reports on Form 8-K,
filed with the Securities and Exchange Commission, and include the
impact of surprise billing legislation and applicable implementing
rules; the impact of the Company’s name change; the impact of the
COVID-19 pandemic on the Company and its financial condition and
results of operations; the effects of economic conditions on the
Company’s business; the effects of the Affordable Care Act and
potential changes thereto or a repeal thereof; the Company’s
relationships with government-sponsored or funded healthcare
programs, including Medicare and Medicaid, and with managed care
organizations and commercial health insurance payors; the Company’s
ability to comply with the terms of its debt financing
arrangements; the Company’s transition to a third-party revenue
cycle management provider; the impact of the divestiture of the
Company’s anesthesiology and radiology medical groups; the impact
of management transitions; the timing and contribution of future
acquisitions; the effects of share repurchases; and the effects of
the Company’s transformation initiatives, including its
reorientation on, and growth strategy for, its pediatrics and
obstetrics business.
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version on businesswire.com: https://www.businesswire.com/news/home/20220822005637/en/
Charles Lynch Senior Vice President, Finance and Strategy
954-384-0175, x 5692 charles.lynch@pediatrix.com
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